Request a Training, Presentation, or Outreach
This is a request for:
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Traing or Presentation
Outreach Event
Who is asking for the Training/Presentation/Outreach?
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Individual
Organization
Full Name of Individual or Organization who is Requesting the Training/Presentation/Outreach
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Street Address of Individual or Organization who is Requesting the Training/Presentation/Outreach
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Individual or Organization who is Requesting the Training/Presentation/Outreach
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Please enter a valid phone number.
Email of Individual or Organization who is Requesting the Training/Presentation/Outreach
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example@example.com
Who is the Expected Audience for the Training/Presentation/Outreach?
e.g. individuals with disabilities; parents of children with disabilities; family members of adults with disabilities; veterans; service providers; other professionals, etc.
How many Audience Memebers are Expected to Attend?
What County or Counties will Audience Members be From?
Adams County, PA
Allegheny County, PA
Armstrong County, PA
Beaver County, PA
Bedford County, PA
Berks County, PA
Blair County, PA
Bradford County, PA
Bucks County, PA
Butler County, PA
Cambria County, PA
Cameron County, PA
Carbon County, PA
Centre County, PA
Chester County, PA
Clarion County, PA
Clearfield County, PA
Clinton County, PA
Columbia County, PA
Crawford County, PA
Cumberland County, PA
Dauphin County, PA
Delaware County, PA
Elk County, PA
Erie County, PA
Fayette County, PA
Forest County, PA
Franklin County, PA
Fulton County, PA
Greene County, PA
Huntingdon County, PA
Indiana County, PA
Jefferson County, PA
Juniata County, PA
Lackawanna County, PA
Lancaster County, PA
Lawrence County, PA
Lebanon County, PA
Lehigh County, PA
Luzerne County, PA
Lycoming County, PA
McKean County, PA
Mercer County, PA
Mifflin County, PA
Monroe County, PA
Montgomery County, PA
Montour County, PA
Northampton County, PA
Northumberland County, PA
Perry County, PA
Philadelphia County, PA
Pike County, PA
Potter County, PA
Schuylkill County, PA
Snyder County, PA
Somerset County, PA
Sullivan County, PA
Susquehanna County, PA
Tioga County, PA
Union County, PA
Venango County, PA
Warren County, PA
Washington County, PA
Wayne County, PA
Westmoreland County, PA
Wyoming County, PA
York County, PA
This is a request for a:
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Virtual/Remote Training/Presentation/Outreach
In-Person Training/Presentation/Outreach
Either a Virtual/Remote or an In-Person Training/Presentation/Outreach
Requested Topic(s) to be Covered for the Training/Presentation/Outreach?
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Message
Please verify that you are human
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Submit
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